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General NPI Number Information
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NPI Number | 1124153812
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Entity Type | Organization
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Legal Business Name | PBR OPTOMETRISTS LTD OF WINDOM
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 04/02/2008
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Provider Practice Location Address
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Address Line | 1006 4TH AVE
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City | WINDOM
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State | MN
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Zip | 56101-1440
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Country | US
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Telephone | 507-831-2429
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Fax | 507-831-4243
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Provider Business Mailing Address
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Address Line | 1006 4TH AVE PO BOX 160
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City | WINDOM
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State | MN
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Zip | 56101-1440
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Country | US
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Telephone | 507-831-2429
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Fax | 507-831-4243
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Authorized Official
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Title or Position | OWNER
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Name | BRIAN D TEMME
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Credential | O.D.
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Telephone | 507-831-2429
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2062
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License Number State | MN
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